Non-invasive brain stimulation in chronic obstructive pulmonary disease: a case series
DOI:
https://doi.org/10.34024/rnc.2024.v32.15956Keywords:
COPD, inspiratory muscle training, Neuromodulation, functional capacity, dyspneaAbstract
Introduction. Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease characterized by symptoms such as dyspnea, cough, and persistent airway obstruction. Exercise intolerance is frequently found in this population, as well as limitations in respiratory capacity, airway obstruction and respiratory muscle fatigue. Objectives. This study aims to evaluate the effects of stimulation of the diaphragmatic motor cortex by High definition - transcranial direct current stimulation (HD-tDCS) associated with an inspiratory muscle training (IMT) protocol on the functional capacity and sensation of dyspnea in patients with COPD. Method. This case series followed three patients with different degrees of pulmonary involvement due to COPD, who underwent a 20-minute protocol of HD-tDCS associated with IMT, performed twice a week for 6 weeks. Results. After the protocol, an improvement of 22 meters in the 6MWT and 1.66 in the modified Medical Research Council (mMRC) was observed. We can also observe an increase in sustained IMP and respiratory muscle resistance with respective average gains (20.55 and 6.67 cmH2O) between the two moments. Conclusions. These results show that HD-tDCS associated with IMT has beneficial effects on the sensation of dyspnea, functional capacity, respiratory muscle strength and resistance in patients with COPD.
Downloads
References
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2023 report). 2023 (acessado em: 18/09/2023). Disponível em: https://goldcopd.org/2023-gold-report-2/
Maltais F, Decramer M, Casaburi R, Barreiro E, Burelle Y, Debigare R, et al. An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Resp Crit Care Med 2014;189:e15-62. https://doi.org/10.1164/rccm.201402-0373ST
Singer J, Yelin EH, Katz PP, Sanchez G, Iribarren C, Eisner MD, et al. Respiratory and skeletal muscle strength in chronic obstructive pulmonary disease: impact on exercise capacity and lower extremity function. J Card Rehab Prev 2011;31:111-9. https://doi.org/10.1097/HCR.0b013e3182033663
Mantoani LC, Rubio N, McKinstry B, MacNee W, Rabinovich RA. Interventions to modify physical activity in patients with COPD: a systematic review. Eur Resp J 2016;48:69-81. https://doi.org/10.1183/13993003.01744-2015
Watz H, Pitta F, Rochester CL, Garcia-Aymerich J, ZuWallack R, Troosters T, et al. An official European Respiratory Society statement on physical activity in COPD. Eur Resp J 2014;44:1521-37. https://doi.org/10.1183/09031936.00046814
Silva CMDSE, Gomes Neto M, Saquetto MB, Conceição CSD, Souza-Machado A. Effects of upper limb resistance exercise on aerobic capacity, muscle strength, and quality of life in COPD patients: a randomized controlled trial. Clin Rehab 2018;32:1636-44. https://doi.org/10.1177/0269215518787338
Pilloni G, Bikson M, Badran BW, George MS, Kautz SA, Okano AH, et al. Update on the use of transcranial electrical brain stimulation to manage acute and chronic COVID-19 symptoms. Front Hum Neurol 2020;14:595567. https://doi.org/10.3389/fnhum.2020.595567
Laviolette L, Niérat MC, Hudson AL, Raux M, Allard E, Similowski T. The supplementary motor area exerts a tonic excitatory influence on corticospinal projections to phrenic motoneurons in awake humans. PloS One 2013;8:1-9. https://doi.org/10.1371/journal.pone.0062258
Nakayama T, Fujii Y, Suzuki K, Kanazawa I, Nakada T. The primary motor area for voluntary diaphragmatic motion identified by high field fMRI. J Neurol 2004;251:730-5. https://doi.org/10.1007/s00415-004-0413-4
Azabou E, Bao G, Heming N, Bounab R, Moine P, Chevallier S. Randomized controlled study evaluating efficiency of low intensity transcranial direct current stimulation (tDCS) for dyspnea relief in mechanically ventilated COVID-19 patients in ICU: the tDCS-DYSP-COVID protocol. Front Med 2020;7:558317. https://doi.org/10.3389/fmed.2020.00372
Pollastri L, Gallo G, Zucca M, Filipas L, La Torre A, Riba U, et al. Bilateral Dorsolateral Prefrontal Cortex High-Definition Transcranial Direct-Current Stimulation Improves Time-Trial Performance in Elite Cyclists. Int J Sport Phys Perform 2021;16:224-31. https://doi.org/10.1123/ijspp.2019-0910
Andrade SM, Batista LM, Nogueira LL, Oliveira EAD, Carvalho AG, Lima SS. Constraint-induced movement therapy combined with transcranial direct current stimulation over premotor cortex improves motor function in severe stroke: a pilot randomized controlled trial. Rehabil Res Pract 2017;2017:6842549. https://doi.org/10.1155/2017/6842549
Azabou E, Roche N, Sharshar T, Bussel B, Lofaso F, Petitjean M. Transcranial direct-current stimulation reduced the excitability of diaphragmatic corticospinal pathways whatever the polarity used. Resp Phys Neurol 2013;189:183-7. https://doi.org/10.1016/j.resp.2013.07.024
Raux M, Xie H, Similowski T, Koski L. Facilitatory conditioning of the supplementary motor area in humans enhances the corticophrenic responsiveness to transcranial magnetic stimulation. J Appl Phys 2012;108:39-46. https://doi.org/10.1152/japplphysiol.91454.2008
Abodonya AM, Abdelbasset WK, Awad EA, Elalfy IE, Salem HA, Elsayed SH. Inspiratory muscle training for recovered COVID-19 patients after weaning from mechanical ventilation: A pilot control clinical study. Medicine 2021;100:e25339. https://doi.org/10.1097/MD.0000000000025339
Dias FD, Sampaio LMM, Silva GA, Gomes ÉLD, Nascimento ESP, Alves VLS. Home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized clinical trial. Int J Chron Obstruct Pulmon Dis 2013;8:537-44. https://doi.org/10.2147/COPD.S50213
Ministério da Saúde. Relatório de Recomendação: protocolo clínico e diretrizes terapêuticas da doença pulmonar obstrutiva crônica. Conitec, 2021 (acessado em: 13/09/2023). Disponível em: https://www.gov.br/saude/pt-br/assuntos/protocolos-clinicos-e-diretrizes-terapeuticas-pcdt
Santoro A, Tomino C, Prinzi G, Lamonaca P, Cardaci V, Fini M, et al. Tobacco smoking: risk to develop addiction, chronic obstructive pulmonary disease, and lung cancer. Rec Pat Anti-Can D Disc 2019;14:39-52. https://doi.org/10.2174/1574892814666190102122848
Nascimento LCS, Nunes LKRS, Santos EA, Alves ASS. Physiotherapy approach in the lung rehabilitation of COPD patients: an integrative review. RSD 2022;11:e496111033249. https://doi.org/10.33448/rsd-v11i10.33249
Andrade JD, Barreto Neto J, Teixeira AKAAF, Tojal AST, Cerqueira Neto ML, Oliveira GU, et al. Existe correlação entre escala modified medical research concil e teste de caminhada de 6 minutos em DPOC? VIII SULBRAFIR. ASSOBRAFIR Ciência 2015;6(suppl 1):236. https://assobrafirciencia.org/article/5ddbc9dc0e88250c62f2c91e/pdf/assobrafir-6-Suplemento+1-213.pdf
Gosselink R, De Vos J, Van Den Heuvel SP, Segers J, Decramer M, Kwakkel G. Impact of inspiratory muscle training in patients with COPD: what is the evidence?. Eur Resp J 2011;37:416-25. https://doi.org/10.1183/09031936.00031810
Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J. American thoracic society/European respiratory society statement on pulmonary rehabilitation. Am J Resp Crit Care Med 2006;173:1390-413. https://doi.org/10.1164/rccm.200508-1211ST
Mota JC, Santos MRD, Sousa LRD, Abdoral PRG, Abdoral LSR, Miranda CJCDP. Treinamento muscular inspiratório em pessoas com doença pulmonar obstrutiva crônica (DPOC): uma revisão sistemática. Fisioter Pesq 2023;30:e21028823en. https://doi.org/10.1590/1809-2950/e21028823pt
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Aline Araújo Candeia, Wanessa do Nascimento Ferreira, Roberto Vinicius Antonio da Costa, Laura Natália Freitas Cavalcante Tenório, Ewerton Graziane Gomes dos Santos, Iara Tainá Cordeiro de Souza, Tatiana Onofre Gama, Jose Heriston de Morais Lima, Rafaela Pedrosa, Eduardo Eriko Tenório França
This work is licensed under a Creative Commons Attribution 4.0 International License.
Português
English
Español
